Effect of Progressive Muscle Relaxation Training on Fear of Falling in the Elderly People

Background and Purpose
The fear of falling is a common issue among older adults, often leading to a more sedentary lifestyle, which can result in deconditioning and an increased risk of future falls. Initially, it was believed that the fear of falling occurred only in individuals with a history of falls. However, later studies have shown that even people without a history of falling can experience a significant fear of falling (Makino et al, 2017). It has been reported that the psychological effects of the fear of falling in the elderly can significantly impact their mobility, reduce daily activities, and decrease their overall quality of life (Bastani et al., 2021). Given these considerations, it is crucial to focus on interventions that target the fear of falling in older adults and improve their quality of life by mitigating the consequences of this fear. However, the ability to engage in physical exercises is often limited in some elderly individuals due to their fear of falling, which presents challenges in implementing rehabilitation programs for these individuals.  (Hosseini et al, 2019). In such situations, Progressive Muscle Relaxation (PMR) exercises may serve as a suitable alternative to physical exercises during the initial stages of the rehabilitation process. These exercises can play a crucial role in advancing the rehabilitation goals for the elderly. Therefore, the aim of this study was to investigate whether the use of PMR exercises at the beginning of the rehabilitation process can have an impact on reducing the fear of falling in older adults.
​Materials and Methods
This quasi-experimental study was conducted using a pre-test and post-test design with two groups: an experimental group and a control group. The statistical population consisted of elderly women aged 60-70 years. From the volunteer participants, a total of 30 qualified individuals were selected and randomly assigned to the experimental group (15 participants) and the control group (15 participants). The inclusion criteria for the study included female gender, age between 60 and 70 years, no regular participation in an exercise program or specific sport, a score of at least 24 on the Falls Efficacy Scale-International (FES-I), no history of chronic diseases, and no use of neuroleptic medications (Hosseini et al., 2019). Screening of the participants was conducted using a personal information form completed prior to the study. Following the completion of the consent form, eligible participants were selected based on the specified criteria and underwent further evaluations. First, the participants completed the Falls Efficacy Scale-International (FES-I) questionnaire, and individuals with moderate to high levels of fear of falling were selected as study samples. After randomly assigning the participants to the groups, the experimental group underwent a Progressive Muscle Relaxation (PMR) exercise protocol for 8 weeks, with 3 sessions per week. It is important to note that PMR exercises have been extensively studied, and their positive effects on various factors, including anxiety control in the elderly, have been well established (Irawati et al., 2021; Yuniartika et al., 2021). Each training session lasted about 45 minutes, with the goal of reducing daily tension and achieving optimal relaxation. The control group was instructed to continue with their usual daily activities and did not participate in any specific sports activities during the study. After 8 weeks, all participants were re-evaluated, and their fear of falling was assessed using the same method as in the pre-test. The data were analyzed using SPSS version 24 software, and to compare the pre-test and post-test scores between the two groups, a Mixed ANOVA test was used (P ≤ 0.05).
Results
An independent t-test was used to assess the homogeneity of the control and experimental groups in the pre-test. The results of this test showed that there were no significant differences between the groups in terms of age, height, weight, and body mass index, indicating that the groups were homogeneous with respect to these variables (P > 0.05). Additionally, an independent t-test was conducted to compare the fear of falling scores between the control and experimental groups, and it was determined that there were no significant differences between the groups in this regard, confirming their homogeneity in these variables as well (P > 0.05). As mentioned earlier, the Mixed ANOVA test was used to assess the changes in fear of falling scores. The results of this test indicated that a significant interaction between time (pre-test, post-test) and group (control, experimental) in relation to the fear of falling scores (P < 0.05). Additionally, it was found that both the main effect of time and the main effect of group were significant (P < 0.05).
 Discussion and Conclusion
The results of this study showed that 8 weeks of PMR exercises significantly reduced the fear of falling scores in the elderly. These findings are consistent with previous studies that have evaluated the effects of PMR exercises. For example, Sakhare et al. (2018) reported that PMR exercises can significantly decrease levels of physical and cognitive anxiety, as well as improve the self-confidence of the participants. It is believed that PMR exercises are effective in regulating the function of the posterior and anterior hypothalamus, helping to prevent the negative effects caused by tension and anxiety (Padua et al., 2015). Specifically, muscle relaxation through a series of regular physiological changes leads to a decrease in oxygen consumption, heart rate, and breathing rate, which are indicators of controlling physical anxiety in an individual (Khabiri et al., 2017).
Another possible explanation for the results obtained in this study is the role of PMR exercises in reducing the electrical activity of the muscles and its impact on psychological stress. In this regard, Hashim et al. (2011) reported that PMR is an effective method for reducing mental pressure, significantly decreasing muscle tension, and improving the mental state of individuals. It seems that PMR enhances muscle efficiency by reducing the excitation of the autonomic nervous system, while also increasing parasympathetic activity, which is linked to lower musculoskeletal and cardiovascular tone (Allison et al., 2020). Based on these findings, it is likely that the use of PMR exercises in our study improved the participants' performance by enhancing muscle efficiency, which in turn contributed to a reduction in the fear of falling in the experimental group. In conclusion, the results of this study suggest that 8 weeks of Progressive Muscle Relaxation (PMR) exercises significantly reduce the fear of falling in elderly individuals. While the positive effects of physical exercises on fear of falling have been well-documented, as mentioned earlier, physical exercises may not be feasible for some elderly people (Hosseini et al., 2019). Therefore, it is recommended to incorporate PMR exercises at the beginning of the rehabilitation process for older adults. By performing PMR exercises and potentially reducing the fear of falling, elderly individuals may experience improved conditions that enable them to engage in other physical exercises, thereby benefiting both their physical and psychological well-being.
Funding
This study received no funding from public, commercial, or nonprofit organizations.
Authors’ Contributions
First and Second author: Conceptualization and presentation of the idea, data collection and methodology; Third author: data collection and data analysis. All authors contributed equally to the writing and revision of the article.
Conflicts of Interest
The authors declared no conflict of interest.